Alice Nakiwogga-Muwanga1, Stella Alamo-Talisuna2, Joseph Musaazi3, Andrew Kambugu3, P Ssekawungu3, Elly Katabira4, Robert Colebunders5. 1. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda nakiwoalice@gmail.com. 2. Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda. 3. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. 4. Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. 5. Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Abstract
BACKGROUND: The purpose of this case-control study was to identify risk factors for loss to follow-up (LTFU). METHODS: Cases and controls were selected from HIV-positive patients, aged 18 years and older, on antiretroviral therapy (ART) at the Infectious Diseases Clinic (IDC) in January 2008. As cases, we selected 209 patients who in 2008 did not return to the clinic within 90 days of their scheduled appointment date. As controls, we randomly selected 626 patients from the 5872 patients who were following up at the end of December 2008. RESULTS: In multivariable logistic regression analysis, urban or semiurban residence, World Health Organization disease stage III or IV at ART initiation, a median CD4 count at last visit <200 cells/mm(3), tuberculosis (TB) in the 6 months before the last visit, absence of counseling before ART initiation, and no disclosure of HIV status were associated with LTFU. CONCLUSION: This study demonstrates the importance of close patient monitoring in advanced stages of disease, supportive counseling for patients initiating ART, extra psychosocial support for patients with TB and HIV coinfection, assisting patients with disclosure, and setting up a good referral system to retain patients on ART.
BACKGROUND: The purpose of this case-control study was to identify risk factors for loss to follow-up (LTFU). METHODS: Cases and controls were selected from HIV-positive patients, aged 18 years and older, on antiretroviral therapy (ART) at the Infectious Diseases Clinic (IDC) in January 2008. As cases, we selected 209 patients who in 2008 did not return to the clinic within 90 days of their scheduled appointment date. As controls, we randomly selected 626 patients from the 5872 patients who were following up at the end of December 2008. RESULTS: In multivariable logistic regression analysis, urban or semiurban residence, World Health Organization disease stage III or IV at ART initiation, a median CD4 count at last visit <200 cells/mm(3), tuberculosis (TB) in the 6 months before the last visit, absence of counseling before ART initiation, and no disclosure of HIV status were associated with LTFU. CONCLUSION: This study demonstrates the importance of close patient monitoring in advanced stages of disease, supportive counseling for patients initiating ART, extra psychosocial support for patients with TB and HIV coinfection, assisting patients with disclosure, and setting up a good referral system to retain patients on ART.